title: Two cases of cholestasis in the first trimester of pregnancy after ovarian hyperstimulation.
abstract: OBJECTIVE
  To report two cases of early onset cholestasis of pregnancy associated with IVF and ovarian hyperstimulation syndrome.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University-based IVF program.
  
  
  METHODS
  Two patients with first-trimester cholestasis of pregnancy after IVF that was associated with ovarian hyperstimulation syndrome.
  
  
  METHODS
  In vitro fertilization-embryo transfer, management of hyperstimulation syndrome, and cholestasis of pregnancy.
  
  
  METHODS
  Clinical pregnancy course and pregnancy outcomes.
  
  
  RESULTS
  The first patient was treated with ursodeoxycholic acid and had resolution of symptoms within the first trimester. The second patient initially had a miscarriage but did redevelop cholestasis of pregnancy in the latter stages of a pregnancy resulting from frozen embryo transfer.
  
  
  CONCLUSIONS
  We report two cases of intrahepatic cholestasis of pregnancy in the first trimester of pregnancies by IVF in association with ovarian hyperstimulation syndrome and markedly elevated maternal serum estrogen levels. Early recognition of this unusual clinical presentation allows for optimal pregnancy management by both the reproductive endocrinologist and the obstetrician.
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University Hospital, Stanford, California 94305, USA. amz001@stanford.edu
authors.forename: A Musa
authors.initials: AM
authors.lastname: Zamah
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: El-Sayed
authors.forename: Amin A
authors.initials: AA
authors.lastname: Milki
mesh_terms: D000328:Adult; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000150:complications* / Q000628:therapy*; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis* / Q000209:etiology*; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First